For transcatheter-based minimally invasive procedures in structural heart disease ultrasound and X-ray are the two enabling imaging modalities. A live fusion of both real-time modalities can potentially improve the workflow and the catheter navigation by combining the excellent instrument imaging of X-ray with the high-quality soft tissue imaging of ultrasound. A recently published approach to fuse X-ray fluoroscopy with trans-esophageal echo (TEE) registers the ultrasound probe to X-ray images by a 2D-3D registration method which inherently provides a registration of ultrasound images to X-ray images. In this paper, we significantly accelerate the 2D-3D registration method in this context. The main novelty is to generate the projection images (DRR) of the 3D object not via volume ray-casting but instead via a fast rendering of triangular meshes. This is possible, because in the setting for TEE/X-ray fusion the 3D geometry of the ultrasound probe is known in advance and their main components can be described by triangular meshes. We show that the new approach can achieve a speedup factor up to 65 and does not affect the registration accuracy when used in conjunction with the gradient correlation similarity measure. The improvement is independent of the underlying registration optimizer. Based on the results, a TEE/X-ray fusion could be performed with a higher frame rate and a shorter time lag towards real-time registration performance. The approach could potentially accelerate other applications of 2D-3D registrations, e.g. the registration of implant models with X-ray images.
KEYWORDS: Data modeling, Magnetic resonance imaging, 3D modeling, Heart, Computed tomography, Sensors, Data acquisition, Transparency, Surgery, 4D CT imaging
Congenital heart defect (CHD) is the most common birth defect and a frequent cause of death for children.
Tetralogy of Fallot (ToF) is the most often occurring CHD which affects in particular the pulmonary valve and
trunk. Emerging interventional methods enable percutaneous pulmonary valve implantation, which constitute
an alternative to open heart surgery. While minimal invasive methods become common practice, imaging and
non-invasive assessment tools become crucial components in the clinical setting. Cardiac computed tomography
(CT) and cardiac magnetic resonance imaging (cMRI) are techniques with complementary properties and ability
to acquire multiple non-invasive and accurate scans required for advance evaluation and therapy planning. In
contrary to CT which covers the full 4D information over the cardiac cycle, cMRI often acquires partial information,
for example only one 3D scan of the whole heart in the end-diastolic phase and two 2D planes (long and
short axes) over the whole cardiac cycle. The data acquired in this way is called sparse cMRI. In this paper, we
propose a regression-based approach for the reconstruction of the full 4D pulmonary trunk model from sparse
MRI. The reconstruction approach is based on learning a distance function between the sparse MRI which needs
to be completed and the 4D CT data with the full information used as the training set. The distance is based
on the intrinsic Random Forest similarity which is learnt for the corresponding regression problem of predicting
coordinates of unseen mesh points. Extensive experiments performed on 80 cardiac CT and MR sequences
demonstrated the average speed of 10 seconds and accuracy of 0.1053mm mean absolute error for the proposed
approach. Using the case retrieval workflow and local nearest neighbour regression with the learnt distance function
appears to be competitive with respect to "black box" regression with immediate prediction of coordinates,
while providing transparency to the predictions made.
Disorders of the heart valves constitute a considerable health problem and often require surgical intervention.
Recently various approaches were published seeking to overcome the shortcomings of current clinical practice,that
still relies on manually performed measurements for performance assessment. Clinical decisions are still based on
generic information from clinical guidelines and publications and personal experience of clinicians. We present a
framework for retrieval and decision support using learning based discriminative distance functions and visualization
of patient similarity with relative neighborhood graphsbased on shape and derived features. We considered
two learning based techniques, namely learning from equivalence constraints and the intrinsic Random Forest
distance. The generic approach enables for learning arbitrary user-defined concepts of similarity depending on
the application. This is demonstrated with the proposed applications, including automated diagnosis and interventional
suitability classification, where classification rates of up to 88.9% and 85.9% could be observed on a
set of valve models from 288 and 102 patients respectively.
KEYWORDS: 3D modeling, Data modeling, Principal component analysis, Sensors, Visualization, Distance measurement, Visual process modeling, 3D metrology, Heart, Optical tracking
Aortic valve disorders are the most frequent form of valvular heart disorders (VHD) affecting nearly 3% of
the global population. A large fraction among them are aortic root diseases, such as aortic root aneurysm,
often requiring surgical procedures (valve-sparing) as a treatment. Visual non-invasive assessment techniques
could assist during pre-selection of adequate patients, planning procedures and afterward evaluation of the same.
However state of the art approaches try to model a rather short part of the aortic root, insufficient to assist
the physician during intervention planning. In this paper we propose a novel approach for morphological and
functional quantification of both the aortic valve and the ascending aortic root. A novel physiological shape
model is introduced, consisting of the aortic valve root, leaflets and the ascending aortic root. The model
parameters are hierarchically estimated using robust and fast learning-based methods. Experiments performed
on 63 CT sequences (630 Volumes) and 20 single phase CT volumes demonstrated an accuracy of 1.45mm and
an performance of 30 seconds (3D+t) for this approach. To the best of our knowledge this is the first time a
complete model of the aortic valve (including leaflets) and the ascending aortic root, estimated from CT, has
been proposed.
Disorders of the aortic valve represent a common cardiovascular disease and an important public-health problem
worldwide. Pathological valves are currently determined from 2D images through elaborate qualitative evalu-
ations and complex measurements, potentially inaccurate and tedious to acquire. This paper presents a novel
diagnostic method, which identies diseased valves based on 3D geometrical models constructed from volumetric
data. A parametric model, which includes relevant anatomic landmarks as well as the aortic root and lea
ets,
represents the morphology of the aortic valve. Recently developed robust segmentation methods are applied
to estimate the patient specic model parameters from end-diastolic cardiac CT volumes. A discriminative
distance function, learned from equivalence constraints in the product space of shape coordinates, determines
the corresponding pathology class based on the shape information encoded by the model. Experiments on a
heterogeneous set of 63 patients aected by various diseases demonstrated the performance of our method with
94% correctly classied valves.
Disorders of the mitral valve are second most frequent, cumulating 14 percent of total number of deaths caused
by Valvular Heart Disease each year in the United States and require elaborate clinical management. Visual
and quantitative evaluation of the valve is an important step in the clinical workflow according to experts
as knowledge about mitral morphology and dynamics is crucial for interventional planning. Traditionally
this involves examination and metric analysis of 2D images comprising potential errors being intrinsic to the
method. Recent commercial solutions are limited to specific anatomic components, pathologies and a single
phase of cardiac 4D acquisitions only. This paper introduces a novel approach for morphological and functional
quantification of the mitral valve based on a 4D model estimated from ultrasound data. A physiological model of
the mitral valve, covering the complete anatomy and eventual shape variations, is generated utilizing parametric
spline surfaces constrained by topological and geometrical prior knowledge. The 4D model's parameters are
estimated for each patient using the latest discriminative learning and incremental searching techniques. Precise
evaluation of the anatomy using model-based dynamic measurements and advanced visualization are enabled
through the proposed approach in a reliable, repeatable and reproducible manner. The efficiency and accuracy
of the method is demonstrated through experiments and an initial validation based on clinical research results.
To the best of our knowledge this is the first time such a patient specific 4D mitral valve model is proposed,
covering all of the relevant anatomies and enabling to model the common pathologies at once.
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